AB0224 JAK-INHIBITORS ATTAIN A RAPID AND PERSISTENT EFFECTIVENESS ON SEVERAL PATIENT-REPORTED OUTCOMES IN LONG-STANDING RHEUMATOID ARTHRITIS
Authors: S. Monti, E. Bozzalla Cassione, M. Biggioggero, G. Crepaldi, C. Bazzani, C. Lomater, R. Gorla, E. Favalli, S. Balduzzi, R. Caporali, C. Montecucco
Journal: Annals of the Rheumatic Diseases (2022)

Background Janus kinase inhibitors (JAKi) are efficacious drugs for the control of disease activity in rheumatoid arthritis (RA). The effect on patient-reported outcomes (PROs) has been shown in randomized clinical trials, but is still largely unknown in real-life scenarios. Objectives To assess the time to onset and magnitude of improvement across a number of different PROs in patients with RA treated with JAKi. Methods Patients were selected from centres involved in the LORHEN Registry. Patients with a diagnosis of RA initiating a JAKi (Baricitinib or Tofacitinib) between May 2019 and February 2020 were clinically assessed at baseline, 8 weeks and 16 weeks with DAS28 and SDAI. PROs were collected at baseline, 2 weeks, 4 weeks, 8 weeks and 16 weeks from JAKi initiation. The PROs assessed at each timepoint were: Patient Global Assessment (PGA), General Health (GH), 0-100 mm visual analogue scale (VAS)-pain, VAS-fatigue, Health Assessment Questionnaire (HAQ), The Clinical Arthritis Activity (PRO-CLARA) questionnaire. Results Thirty-eight patients (female 76%, mean age 57±15) were enrolled for a total of 152 visits for PROs assessments. Patients had received a median of 2 (IQR 1;3) previous conventional synthetic DMARDs (csDMARD) and a median of 2 (0;3) biological DMARDs. Mean disease duration at time of JAKi initiation was 10±9.5 years. JAKi was prescribed as combination therapy with a csDMARD in 20 (53%), concomitant glucocorticoids (GC) in 28 (73%) patients, at a mean dose of 6±2 mg/day. Twenty-one (55) patients were on regular analgesics. DAS28-ESR reduced from 4.5±0.9 at baseline to 2.6±0.9 at 8 weeks (p&lt;0.001). DAS28-ESR remained stable between 8 and 16 weeks (mean values 2.3±0.1; p=0.17). Similarly, DAS28-CRP reduced from 4.1±0.8 to 2.1±0.6 at 8 weeks (p&lt;0.0001). Between 8 and 16 weeks there was a further significant reduction of DAS28-CRP under the effect of JAKi treatment to a mean value of 1.4±0.5 (p&lt;0.0001). SDAI reduced over the period of observation from 19±8 to 6±5 at 8 weeks (p&lt;0.0001), and to 4±3 at 16 weeks (0.03). By week 8 the intake of concomitant GC reduced to 28% of patients (p=0.0001), and of analgesics to 2% of patients (p&lt;0.0001). By two weeks, all PROs had a significant reduction compared to baseline (Figure 1). For PGA, VAS-pain, VAS-fatigue a further significant reduction was observed by week 4 to then stabilize between week 8 and 16. GH and HAQ had a significant reduction by week 2 and remained stable thereafter. All PROs were significantly lower during all time-points compared to baseline. The PRO-CLARA Road score to assess physical function significantly improved starting from week 2 from a score of 4±2 to 2±2 at the end of follow-up. The PRO-CLARA self-administered tender joint count was stable at week 2 (mean score 4±2) but recorded an improvement from week 4 onwards (p&lt;0.03). Figure 1. Improvement of patient-reported outcomes over the period of observation Conclusion Treatment with JAKi ensures a very rapid and persistent improvement of several PROs, including pain, fatigue and physical function, as early as 2 weeks treatment even in patients with long-standing RA treated with several lines of previous DMARDs. Disclosure of Interests None declared